House, M.D. and the science of psychogenic illness

In an episode of House, M.D. (“Airborne”) an illness spreads among passengers on a commercial airplane via ostensibly non-biological means, creating a mini-epidemic with purely psychological origins. Could something like this happen in real life? Does the mere conviction that one is becoming physically sick increase one’s chances of contracting genuine symptoms of illness? This article explores this issue and in the process evaluates the realism of the plot from “Airborne.”

House, M.D. (don’t you dare forget the comma) is, at its core, a show about medicine and the logic involved in medically diagnosing patients. Greg House, the show’s central character, is an expert in both respects (in order to be a good diagnostician, he has to be) but, as any frequent viewer will tell you, his genius is in no way restricted by his job description. Owing to House’s seemingly limitless brilliance - his uncanny capacity for meticulous observation and intense analysis, along with his unconventional approach to problem-solving – he also qualifies as an expert on
human nature. Again and again, he shows how adept he is at discerning the significant details of people’s behavior, pointing out their true intentions, identifying their irrationalities, and predicting their future actions. He also frequently articulates poignant psychological generalizations, such as, “Everybody lies,” “Humanity is overrated,” and “Overall, drug addicts are idiots,” to list but a few. In short, he is a psychologist of sorts, but technically only an amateur, because he never conducts carefully controlled studies to back up his assertions, the meat of what “real” psychologists do.

That’s where real psychologists and real psychological research come in. These people have the tools to rigorously evaluate many of House’s assumptions about people. Is it true that “people don’t change,” as House claims? How about the idea that “people act in their own self-interests”? Sometimes, when we compare House’s assertions to the findings of psychological research, they fail the test, or appear simplistic, and House is exposed for the amateur that he is. Other times, owing to his instinctive insight, he gets it just right, and we marvel at his brilliance.

To a critical viewer, it can be fun to identify these instances of potential agreement or disagreement between House and scientific findings. One such incident occurred aboard a commercial airplane when Cuddy – House’s boss and future love interest – contracted a set of serious physical symptoms after being exposed to other passengers who were also getting sick. In particular, she was vomiting a lot and her hand was trembling uncontrollably. The interesting thing here was that in the end her symptoms (as well as those of the other passengers) turned out to be wholly
psychogenic, or “in the mind.” Apparently, Cuddy and the other passengers had convinced themselves that they were getting sick, and then proceeded to actually exhibit symptoms as a result. Towards the end of the episode, House sensitively addresses Cuddy’s embarrassment over her extreme hypochondriasis:

House: [to Cuddy] “Happens often in high-anxiety situations, especially to women. I know it sounds sexist, but science says you’re weak and soft. What can I do?”

(Airborne Season 3, Episode 18)

In addition to being entertaining, “Airborne” offered a depiction of the interesting and still poorly understood phenomenon House alludes to in the quote above, a factor House implicates in the rapid spread of a strange and brutal ailment throughout the passenger compartment.

Many might wonder: were the major events in this episode - specifically those involving the mass spread of an illness via non-biological means - an accurate depiction of a real phenomenon or did the writers take a few liberties by exaggerating the details for dramatic effect? Could such events ever play out in real life? What about the “sexist” part of House’s remark? Is that accurate?

To answer those questions, we’ll examine a couple of bizarre incidents that have been well-documented and thoroughly analyzed by a whole raft of intelligent people: medical experts, psychologists, sociologists, etc.

The first such incident occurred in Tanzania in 1962, when three female students began laughing uncontrollably for no apparent reason. The laughter persisted, and it quickly spread to other students at the school. Eventually, this “epidemic of laughter” became so widespread that the school was forced to close, sending all the students home. But that only served to transmit the epidemic to the nearby villages where the children were advised to sequester themselves. Paradoxically, this was not the spread of genuine happiness and joy; to the contrary, afflicted individuals reported feeling restless and fearful. This was obviously, albeit paradoxically, no laughing matter.

The incident sparked a large-scale investigation that, just as in “Airborne,” uncovered no biological causes such as environmental contaminants. Nothing seemed out of the ordinary from that standpoint. So, what was the cause? Based on the absence of other obvious causes, Rankin and Philip (1963) concluded that the nature of the problem was psychological rather than biological; specifically,
mass hysteria was to blame, a condition that stems from the human propensity to exhibit something called
emotional contagion.